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Advanced Illness Care

Advanced Illness Care is a homebased program for patients with UPMC Health Plan coverage who have a serious or advanced illness. It is designed to help patients better cope with their illness and maintain the highest quality of life possible.

At the heart of the program is a team of social workers, Certified Registered Nurse Practitioners (CRNPs), and nurses who visit the patient at home. These experts partner closely with family members and primary care providers.

The team helps the patient with advance care planning, achieving individual goals of care, and decision making in tandem with his or her PCP.

It’s the power of face-to-face, collaborative care — delivered to patients in the comfort of their home.

What does the Advanced Illness Care program offer?

  • Help with treatment plan
  • Help with symptom and pain management
  • Advice and support for family/caregivers
  • Help with advanced care planning
  • Ten home visits per lifetime
  • No member cost-sharing
  • No home-bound status required
The Advanced Illness Care team includes UPMC Health Plan Medical Director oversight, and is further supported by a pharmacist.

Patients that Qualify for the Advanced Illness Care Program

A patient can be referred if he or she is 21 years old or older, is a UPMC Health Plan member, and has experienced at least one of the following:
  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Coronary artery disease
  • Deferred hospice
  • Dementia/Alzheimer’s disease
  • Disenrolled from hospice due to nonprogression of disease
  • End-stage disease but not a candidate for transplant
  • LTAC stay within the past year
  • Liver failure
  • Metastatic cancer
  • Palliative care/supportive services encounter
  • Parkinson’s disease
  • Renal failure/end-stage renal disease
  • Three or more Emergency Room/Urgent Care visits in the past 12 months
  • Three or more inpatient admissions in the past 12 months
  • Two or more ICU stays within the same hospitalization

For more information about the Advanced Illness Care program, or to refer a patient, call 1-800-493-3760 or email the UPMC Health Plan.